The biller has a number of other responsibilities, but for now you should simply know that the biller is in charge of making sure the healthcare provider is properly reimbursed for their services.
In short, a Coder is someone who has a thorough understanding of the ICD-9 codes, Modifiers, and CPT codes and uses this knowledge to ensure the proper application.
Coding accurately and within the specific guidelines for each code will affect the status of a claim.
To get a better look at medical billing, let’s rewind the example we used earlier.
Every code set has its own set of guidelines and rules.
Certain codes, like ones that signify a pre-existing condition, need to be placed in a very particular order.
The biller then sends this claim to the insurance company, which evaluates and returns it.
The biller then evaluates this returned claim and figures out how much of the bill the patient owes, after the insurance is taken out.
Coders most often review the work of the physician, apply modifiers, and check for errors in CPT code bundling or ICD-9(Diagnosis Code) appendage.
For each procedure that the physician or NPP(non-physician provider performs, there is an applicable CPT code and associated Diagnosis code.